The decision to stop using a contraceptive implant and begin trying to conceive is often met with excitement, but a delay in pregnancy can create anxiety. The implant, typically a subdermal device releasing the progestin hormone etonogestrel, is a highly effective form of long-acting reversible contraception. A delay in conception after removal does not mean the implant has caused long-term infertility, which is a common but incorrect concern. Instead, the delay is often due to the time required for the body’s reproductive system to fully reset or due to underlying fertility factors previously masked by the hormonal birth control.
The Immediate Hormonal Reset
The implant works by releasing the synthetic progestin etonogestrel, which primarily prevents ovulation and thickens cervical mucus to block sperm. Once the rod is removed, hormone delivery stops immediately, and etonogestrel clears from the bloodstream quickly, often becoming undetectable within one week.
The body’s reproductive system, specifically the Hypothalamic-Pituitary-Ovarian (HPO) axis, must then reactivate to resume its natural rhythm. This axis controls the release of hormones necessary for follicular development and ovulation. While the chemical signal is gone quickly, the brain’s control center may require a short period to restart communication with the ovaries. For many, ovulation can resume in as little as one to three weeks, demonstrating that the implant does not impair future fertility.
Establishing A Regular Cycle and Typical Timelines
While the return of fertility is rapid, the time it takes to achieve pregnancy is similar to that of women discontinuing other forms of hormonal birth control. The first step is the return of a menstrual period, followed by the establishment of a regular, ovulatory cycle. The return of a period confirms that the uterine lining is shedding, but it does not guarantee that ovulation is consistently occurring.
Most couples successfully achieve pregnancy within six to twelve months of trying, which is the standard timeline for the general population. Studies show that the return to fertility after etonogestrel implant removal is one of the fastest among all hormonal methods. For women who conceive quickly, the average time to conception is often within just two menstrual cycles following the removal.
Underlying Fertility Factors Unrelated to the Implant
If conception does not occur within the typical six to twelve months, the cause is rarely linked to the implant itself but rather to underlying factors that existed before its use. The implant effectively suspended the natural menstrual cycle, which could have masked pre-existing conditions that affect fertility. The single most important factor influencing conception success is advanced maternal age, as both the quality and quantity of a woman’s eggs decline progressively after age 35.
Conditions like Polycystic Ovary Syndrome (PCOS) or thyroid dysfunction may have been hidden by the implant’s use, which often regulated bleeding. PCOS causes irregular or absent ovulation, while an underactive or overactive thyroid can disrupt the hormonal balance needed for a healthy cycle. Furthermore, male factor infertility accounts for about one-third of all conception difficulties and is entirely unrelated to the female partner’s previous implant use.
Male factor issues include problems with sperm count, motility, or shape, and require a separate evaluation. Structural problems, such as blockages in the fallopian tubes, can also prevent the egg and sperm from meeting. These blockages can result from a past infection or condition like endometriosis, and their effect on conception would have been present regardless of the implant.
When to Consult a Fertility Specialist
Knowing when to seek professional evaluation is an important step in the conception journey. For women under the age of 35, the standard guideline is to consult a fertility specialist if conception has not occurred after twelve months of regular, unprotected intercourse. This timeframe allows for the natural variations in the return to a regular cycle and typical conception rates.
If a woman is 35 years or older, it is advisable to seek an evaluation sooner, typically after six months of actively trying to conceive. This accelerated timeline is recommended because fertility declines more rapidly with age, making timely intervention more effective. A specialist should also be consulted immediately if there are specific red flags, such as a known history of endometriosis or PCOS, or if the menstrual period has not returned within three to six months following the implant removal.